The Role of Mini-invasive Surgery in Management of Acute Cholangitis and Other Complications of Gallstone Disease

Aims and objectives: The role of mini-invasive surgery in management of acute cholangitis and other complications of gallstone diseaseBackground: To demonstrate the capability of laparoscopic and small-incision in management of acute cholangitis and other complications of cholelithiasis.Material and methods: Records of 2973 patients who underwent cholecystectomy at Department of General Surgery, Rostov State Medical University between the year 2004 and 2007 were reviewed.Three hundred ninety two cases of gallstone-related complications were evaluated retroprospectively and divided into three groups. Group1; LC included 258(65.8%) patients with laparoscopy cholecystectomy. Group 2; MC included 84(21.4%) patients with minilaparotomy cholecystectomy, while Group 3; OC included 50(12.8%) patients with conventional open cholecystectomy.Demographic information, clinical characteristics, types of surgery, operation time, postoperative hospital stay, complications, conversion rate and postoperative mortality were evaluated.Results: The age range of all subjects was 15 to 86 years; the mean age incidence was 57.12±1.60 years, and the male: female ratio was 1:3.4.The age of 81.5% of all patients was 51 to 80 years. There were 27 (6.8%) patients out of the 392 cases presented with a combination of acute pyegenic cholangitis with other complications of cholelithiasis; mechanical jaundice in 26(88.9%), choledocholythias in 22(81.5%),biliary pancreatitis in 7(25.9%), common bile duct strictures in 5(18.5%) ,pericholecystic fibrotic mass in 4(14.8%) and empyema in 3 (11.1%). Twenty three (85.2%) subjects had three and more of such combinations. Seventeen patients (63.0%) were associated with concomitant diseases.The average duration of surgery in LC was 72 ± 9 minutes and 55 ± 2 minutes in MC group. Hospital days were comparatively less in the LC group, 11.4±0 .6 days as against 16.3± 2.3 for MC group. The median length of hospital stay following LC and MC was 7 and 10 days respectively.Conclusion: Both mini-incision and laparoscopic prompt cholecystectomy during the index admission can be practiced with low and similar rate of complications in cholangitis and gallstones related complications